Changes in intracranial stenotic lesions after extracranial-intracranial bypass surgery

1984 ◽  
Vol 60 (4) ◽  
pp. 771-776 ◽  
Author(s):  
Issam Awad ◽  
Anthony J. Furlan ◽  
John R. Little
Keyword(s):  
Bypass Surgery ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Content Type ◽  
Stenotic Lesion ◽  
Bypass Patency ◽  
History Of ◽  
Stenotic Lesions

✓ The natural history of intracranial arterial stenosis is not well understood. The lesions are pathologically quite diverse, and are subject to resolution, progression, or occlusion. The authors undertook an investigation to examine what effects, if any, extracranial-intracranial (EC-IC) bypass surgery had on the evolution of intracranial arterial stenosis in 18 patients undergoing EC-IC bypass procedures for ipsilateral hemispheric ischemia. There was inaccessible internal carotid artery stenosis in 14 patients, and middle cerebral artery stenosis in four patients. Early (within 2 weeks) and late (at 6 months) postoperative angiography was performed in all patients. During the period of the study, there was a significant change in the arterial stenosis in 50% of the patients (nine of 18). The stenotic artery became occluded in four patients while the grafts were widely patent. The occlusion occurred within a few days after the operation in three of the four cases, and was accompanied by an ischemic stroke in these patients. There was improvement or resolution of the stenotic lesion in five patients; the graft became occluded in two of these cases and was patent but showed poor cortical artery filling in the other three. All these patients remained asymptomatic and the change was detected on routine late postoperative angiograms. It is concluded that arterial stenoses should not be viewed as static or inflexible lesions, and that EC-IC bypass procedures can modify the hemodynamic parameters across stenotic lesions, predisposing them to improvement or worsening. This, in turn, may affect bypass patency. Such hemodynamic interactions are accompanied by ischemic symptoms in some patients, and contribute to the relatively higher morbidity associated with EC-IC bypass surgery in the setting of arterial stenosis.

Bypass surgery in patients with intracranial stenotic lesions

1985 ◽  
Vol 62 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Collice Massimo ◽  
Arena Orazio ◽  
Filizzolo Felice
Keyword(s):  
Cerebral Artery ◽  
Postoperative Morbidity ◽  
Neurological Complications ◽  
High Rate ◽  
Arterial Stenosis ◽  
Content Type ◽  
Stenotic Arteries ◽  
Stenotic Lesions ◽  
Very High

✓ Postoperative morbidity in patients with intracranial stenotic lesions following extracranial-intracranial arterial (EC-IC) bypass is not well defined. A high rate of neurological complications associated with occlusion of the stenotic arteries after surgery has recently been reported. In the period June, 1976, to March, 1984, the authors performed EC-IC bypass procedures in 19 patients with intracranial stenotic arteries. Most of the patients were initially treated pharmacologically (usually by anticoagulant therapy). Surgery was performed if the symptoms recurred while the patients were under pharmacological treatment and if angiography confirmed arterial stenosis. Antiplatelet therapy was given until the day of surgery and during the entire follow-up period. No permanent postoperative morbidity was observed in the series. One patient, with stenosis of the left siphon, the A1 segment of the anterior cerebral artery, and the M1 segment of the middle cerebral artery, had a transient dysphasia and right hemiparesis (lasting 3 days) in the presence of an unchanged arterial stenosis. In five patients early postoperative angiography (at 5 to 21 days) revealed occlusion of previously stenotic arteries. In one patient the occlusion was disclosed only on a later angiographic study, 2 months after surgery. Although EC-IC bypass is generally not a very high-risk operation in patients with intracranial arterial stenosis, there is a high percentage of immediate postoperative occlusion, and the authors suggest caution in determining indication for surgical treatment.

Long-term natural history of hemorrhagic type moyamoya disease in 42 patients

2000 ◽  
Vol 93 (6) ◽  
pp. 976-980 ◽  
Author(s):  
Eiichi Kobayashi ◽  
Naokatsu Saeki ◽  
Hiromichi Oishi ◽  
Shinji Hirai ◽  
Akira Yamaura
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Bleeding Episode ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The purpose of this study was to delineate the long-term natural history of hemorrhagic moyamoya disease (MMD).Methods. A retrospective review was conducted among 42 patients suffering from hemorrhagic MMD who had been treated conservatively without bypass surgery. The group included four patients who had undergone indirect bypass surgery after an episode of rebleeding. The follow-up period averaged 80.6 months. The clinical features of the first bleeding episode and repeated bleeding episodes were analyzed to determine the risk factors of rebleeding and poor outcome.Intraventricular hemorrhage with or without intracerebral hemorrhage was a dominant finding on computerized tomography scans during the first bleeding episode in 29 cases (69%). During the follow-up period, 14 patients experienced a second episode of bleeding, which occurred 10 years or longer after the original hemorrhage in five cases (35.7%). The annual rebleeding rate was 7.09%/person/year. The second bleeding episode was characterized by a change in which hemisphere bleeding occurred in three cases (21.4%) and by the type of bleeding in seven cases (50%). After rebleeding the rate of good recovery fell from 45.5% to 21.4% and the mortality rate rose from 6.8% to 28.6%. Rebleeding and patient age were statistically significant risk factors of poor outcome. All four patients in whom there was indirect revascularization after the second bleeding episode experienced a repeated bleeding episode within 8 years.Conclusions. The occurrence of rebleeding a long time after the first hemorrhagic episode was not uncommon. Furthermore, the change in which hemisphere and the type of bleeding that occurred after the first episode suggested the difficulty encountered in the prevention of repeated hemorrhage.

Revascularization surgery for symptomatic non-moyamoya intracranial arterial stenosis or occlusion

2020 ◽  
Vol 132 (2) ◽  
pp. 415-420 ◽  
Author(s):  
Manuri Gunawardena ◽  
Jeffrey M. Rogers ◽  
Marcus A. Stoodley ◽  
Michael K. Morgan
Keyword(s):  
Neurological Deficit ◽  
Bypass Surgery ◽  
Arterial Occlusion ◽  
Arterial Stenosis ◽  
Minimal Risk ◽  
Complication Rates ◽  
Intracranial Arterial Stenosis ◽  
Anterior Circulation ◽  
Poor Outcome ◽  
Revascularization Surgery

OBJECTIVEPrevious trials rejected a role of extracranial-to-intracranial bypass surgery for managing symptomatic atheromatous disease. However, hemodynamic insufficiency may still be a rationale for surgery, provided the bypass can be performed with low morbidity and patency is robust.METHODSConsecutive patients undergoing bypass surgery for symptomatic non-moyamoya intracranial arterial stenosis or occlusion were retrospectively identified. The clinical course and surgical outcomes of the cohort were evaluated at 6 weeks, 6 months, and annually thereafter.RESULTSFrom 1992 to 2017, 112 patients underwent 127 bypasses. The angiographic abnormality was arterial occlusion in 80% and stenosis in 20%. Procedures were performed to prevent future stroke (76%) and stroke reversal (24%), with revascularization using an arterial pedicle graft in 80% and venous interposition graft (VIG) in 20%. A poor outcome (bypass occlusion, new stroke, new neurological deficit, or worsening neurological deficit) occurred in 8.9% of patients, with arterial pedicle grafts (odds ratio [OR] 0.15), bypass for prophylaxis against future stroke (OR 0.11), or anterior circulation bypass (OR 0.17) identified as protective factors. Over the first 8 years following surgery the 66 cases exhibiting all three of these characteristics had minimal risk of a poor outcome (95% confidence interval 0%–6.6%).CONCLUSIONSProphylactic arterial pedicle bypass surgery for anterior circulation ischemia is associated with high graft patency and low stroke and surgical complication rates. Higher risks are associated with acute procedures, typically for posterior circulation pathology and requiring VIGs. A carefully selected subgroup of individuals with hemodynamic insufficiency and ischemic symptoms is likely to benefit from cerebral revascularization surgery.

The Natural History of Amaurosis Fugax with Minor Degrees of Internal Carotid Artery Stenosis

1990 ◽  
Vol 4 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Shlomo Torem ◽  
Mary E. Rossman ◽  
Peter A. Schneider ◽  
Shirley M. Otis ◽  
Ralph B. Dilley ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Amaurosis Fugax ◽  
History Of

Long-term natural history of intracranial arterial stenosis: An MRA follow-up study

2013 ◽  
Vol 333 ◽  
pp. e225
Author(s):  
Y. Kim ◽  
W.S. Ryu ◽  
S.S. Park ◽  
Y.S. Kim ◽  
S.H. Lee ◽  
...  
Keyword(s):  
Natural History ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Follow Up Study ◽  
History Of

scholarly journals Undersized angioplasty and stenting of symptomatic intracranial tight stenosis with Enterprise: Evaluation of clinical and vascular outcome

2015 ◽  
Vol 22 (2) ◽  
pp. 187-195 ◽  
Author(s):  
Kun-Yu Lee ◽  
David Yen-Ting Chen ◽  
Hui-Ling Hsu ◽  
Chi-Jen Chen ◽  
Ying-Chi Tseng
Keyword(s):  
Medical Therapy ◽  
Arterial Stenosis ◽  
Modified Rankin Scale ◽  
Intracranial Arterial Stenosis ◽  
Stent Deployment ◽  
Technical Success Rate ◽  
Stent Restenosis ◽  
Intracranial Atherosclerotic Disease ◽  
Stenotic Lesions

Background Severe intracranial arterial stenosis results in more than 10% incidence of stroke and transient ischemic attack. Using undersized angioplasty with off-label closed-cell Enterprise stent may be a feasible alternative option for treating patients with intracranial atherosclerotic disease who fail dual-antiplatelet medical therapy. The results of the authors’ study are presented in this paper. Materials and methods Between January 2013 and July 2014, 24 symptomatic patients with a total of 30 intracranial arterial stenotic lesions refractory to medical therapy, who underwent undersized angioplasty and Enterprise stenting, were retrospectively reviewed in the authors’ institution. The results evaluated include technical success rate, clinical outcome measured as modified Rankin Scale at presentation and follow-up, peri-procedural morbidity within 30 days and 1 year, and follow-up vessel patency. Results Stent deployment was successfully achieved in all stenotic lesions (30/30). Mean pre-stent and post-stent diameter residual stenosis was 81% and 18%, respectively. The peri-procedural complication rate during 30 days after stenting was 10% per lesion (3/30), including intracranial hemorrhage, in-stent thrombosis and ischemic stroke. No further thromboembolic event or complication occurred in any patient more than 30 days after stenting. Modified Rankin scale ≤ 2 was observed in 64% and 83% of patients at initial presentation and follow-up (mean 15.8 months), respectively. Imaging follow-up was available in 17 of 24 patients (70.8%) and 20 of 30 treated lesions (66.6%) with a mean follow-up period of 15.4 months. Only one asymptomatic in-stent restenosis occurred in 20 available lesions (5.0%). Conclusion This preliminary study suggests that using undersized angioplasty and Enterprise stenting may effectively treat high-degree symptomatic intracranial arterial stenosis with favorable clinical and angiographic outcome.

Intraoperative control of extracranial—intracranial bypass patency by near-infrared indocyanine green videoangiography

2005 ◽  
Vol 102 (4) ◽  
pp. 692-698 ◽  
Author(s):  
Johannes Woitzik ◽  
Peter Horn ◽  
Peter Vajkoczy ◽  
Peter Schmiedek
Keyword(s):  
Indocyanine Green ◽  
Ct Angiography ◽  
Bypass Surgery ◽  
Near Infrared ◽  
Bypass Graft ◽  
High Flow ◽  
Indocyanine Green Videoangiography ◽  
Content Type ◽  
Bypass Patency ◽  
Fine Print

Object. Recently, intraoperative fluorescence angiography in which indocyanine green (ICG) is used as a tracer has been introduced as a novel technique to confirm successful aneurysm clipping. The aim of the present study was to assess whether ICG videoangiography is also suitable for intraoperative confirmation of extracranial—intracranial bypass patency. Methods. Forty patients undergoing cerebral revascularization for hemodynamic cerebral ischemia (11 patients), moyamoya disease (18 patients), or complex intracranial aneurysms (11 patients) were included. Superficial temporal artery (STA)—middle cerebral artery (MCA) bypass surgery was performed 35 times in 30 patients (five patients with moyamoya underwent bilateral procedures), STA—posterior cerebral artery bypass surgery in two patients, and saphenous vein (SV) high-flow bypass surgery in eight patients. In each patient, following the completion of the anastomosis, ICG (0.3 mg/kg body weight) was given systemically via an intravenous bolus injection. A near-infrared light emitted by laser diodes was used to illuminate the operating field and the intravascular fluorescence was recorded using an optical filter—equipped video camera. The findings of ICG videoangiography were compared with those of postoperative digital subtraction (DS) or computerized tomography (CT) angiography. In all cases excellent visualization of cerebral arteries, the bypass graft, and brain perfusion was noted. Indocyanine green videoangiography was used to identify four nonfunctioning STA—MCA bypasses, which could be revised successfully in all cases. In two cases of SV high-flow bypasses, ICG videoangiography revealed stenosis at the proximal anastomotic site, which was also revised successfully. In all cases the final findings of ICG videoangiography could be positively validated during the postoperative course by performing DS or CT angiography. Conclusions. Indocyanine green videoangiography provides a reliable and rapid intraoperative assessment of bypass patency. Thus, ICG videoangiography may help reduce the incidence of early bypass graft failure.

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